The Role of the C-L Psychiatrist in Perinatal Collaborative Care: A Mixed Methods Analysis

Background:

The Collaborative Care Model (CoCM) is an effective primary care-based intervention for depression which has had slow adoption into widespread practice. A psychiatric consultant is a key member of CoCM teams, and in perinatal CoCM this role is often filled by a Consultation Liaison trained psychiatrist with interest or expertise in women’s mental health. Psychiatrists do not always receive in depth training in integrated care or women’s mental health and this may pose a barrier to practicing in the perinatal CoCM. We plan to assess psychiatric consultants’ experiences of practicing in the perinatal CoCM. We conducted a qualitative analysis of data from 20 clinics within a clinical trial comparing the Longitudinal Remote Consultation strategy to standard implementation (trials.gov NCT02976025).



Methods:

We used data from our documentation of team members in each clinic, and from in depth interviews with psychiatric consultants and care managers. We conducted a content analysis of interview responses in six categories (team based practice, remote practice, need for additional training/technical assistance, comfort prescribing in the perinatal population, and perceptions about the CoCM).



Results:

Of the 20 participating clinics, 50% (n=10) had a psychiatric practitioner within the organization who became part of the CoCM team, 20% had (n=4) had a psychiatric practitioner who did not participate in CoCM, 15% (n=3) could not hire a psychiatric consultant and 15% (n=3) hired a psychiatric consultant to build the CoCM team.

We will report on content analysis of 10 psychiatric consultant interviews from eight different clinical sites and 39 care manager interviews from 17 sites, at different points in implementation and sustainment of perinatal collaborative care.





Conclusions:

Challenges to high fidelity implementation of the CoCM model include the ability to recruit psychiatric consultants to the CoCM team, and once recruited their comfort and interest in practicing in this role. Our analysis will help elucidate barriers to implementation that are specific to the psychiatric consultant role and inform future efforts to implement perinatal collaborative care.